Pediatric Gastrointestinal Care Flashcards
The primary function of the gastrointestinal (GI) tract is:
the digestion and absorption of nutrients
Meconium
A thick greenish black material consisting of epithelial cells, digestive tract secretions, and residue of swallowed amniotic fluid, is normally expelled from the intestine shortly after birth and provides evidence of patency of the GI tract.
Newborn swallowing
is an automatic reflex action for the first 3 months, and the infant has no voluntary control of swallowing until the striated muscles in the throat establish their cerebral connections. This begins at about 6 weeks of age.
At what age is the infant capable of swallowing, holding food in the mouth, or spitting it out at will?
6 months.
Pediatric stomach
Round until age 2, then gradually elongates until age 7 when it assumes the shape and anatomic position of the adult stomach.
Infant stomach
The stomach capacity of the infant is smaller than older children, but the emptying time is faster.
What 3 processes are necessary for the body to convert nutrients into forms it can use?
Digestion, absorption, and metabolism.
Nutrients are composed of 6 major substances:
carbohydrates proteins fats vitamins minerals water
Digestions is…
the initial preparation of food for use by the body.
Mechanical digestion
occurs through a series of neuromuscular actions that move and mix food along the GI tract at a rate suitable for digestion and absorption.
Chemical digestion
involves five types of GI secretions: enzymes, hormones, hydrochloric acid, mucus, and water and electrolytes.
The principle site for absorption of nutrients in the GI tract is the
small intestine
The most common consequences of GI disease in children include:
malabsorption
fluid and electrolyte disturbances
malnutrition
poor growth
In GI assessment, the most important basic nursing assessments include:
measurement of intake and output, height and weight, abdominal examination, and simple stool and urine tests.
PICA
an eating disorder characterized by the compulsive and excessive ingestion of both food and nonfood substances.
PICA is more commonly found in:
children, women (especially during pregnancy), individuals who have autism or cognitive impairment, and those with anemia or chronic renal failure.
PICA is clearly associated with the deficiencies of
iron and zinc
PICA for dirt (geophagia)
is the principle risk factor for visceral larva migrans ( a common parasite in children and adults)
Encopresis
overflow of incontinent stool causing soiling; often caused by fecal retention or impaction
Hematochezia
passage of bright red blood per rectum, usually indicating lower GI tract bleeding
Melena
passage of dark-colored, tarry stools caused by denatured blood, suggesting upper GI tract bleeding or bleeding from the right colon
Foreign body ingestions are most common in:
infants and children between the ages of 6 months and 3 years of age, and are the leading cause of accidental death in children less than 6 years of age. The peak incidence is between 1 and 2 years of age.
Primary nursing intervention when considering foreign body airway obstructions
prevention of foreign body ingestion through family teaching.
Constipation
- is a symptom, not a disease
- is defined as a decrease in bowel movement frequency or trouble defecating for more than 2 weeks.
Obstipation
having extremely long intervals between defecation
Systemic disorders associated with constipation include:
hypothyroidism Hypercalcemia chronic lead poisoning antacids diuretics antiepileptics antihistamines opioids iron supplements spinal cord lesions
Idiopathic or functional constipation
no underlying cause can be identified
Chronic constipation
environmental or psychosocial factors
Most constipation in early childhood is
due to environmental changes or normal development when a child begins to attain control over bodily functions. A child who has experienced discomfort during bowel movements may deliberately try to withhold stool.
Stool softeners such as _______ or ________ may be used for hard stools or anal fissures.
Malt extract
lactulose
Hirschsprung disease (congenital aganglionic megacolon) (HD)
a congenital anomaly that results in mechanical obstruction from inadequate motility of part of the intestine.
Pathology of HD
absence of ganglion cells in the affected areas of the intestine, resulting in a loss of the rectosphincteric reflex and an abnormal microenvironment of the cells of the affected intestine.
In most cases the aganglionic segment includes the rectum and some portion of the distal colon.
Clinical manifestations of HD
- most children are diagnosed in the first few months of life.
- more common in males with Downs Syndrome
- clinical manifestations vary according to the age when symprtoms are recognized and the presence of complications, such as enterocolitis.
- A neonate usually is seen with distended abdomen, feeding intolerance with bilious vomiting, and delay in the passage of meconium.
- In older children a careful history is helpful.
Therapeutic management of HD
- Majority of children require surgery rather than medical therapy with frequent enemas.
- Snare biopsy to locate aganglionic bowel
- Surgical management consists primarily of the removal of the aganglionic portion of the bowel to relieve obstruction, restore normal motility, and preserve the function of the external anal sphincter.
- Constipation and fecal incontinence are chronic problems in a significant proportion of patients after surgical correction.
What is the most serious complication of HD?
enterocolitis
